Diabetes: worse than we thought

Latest research shows diabetes burden is larger than estimated and rates of amputations in Australia are seriously high

A study led by Monash University researchers has found there may be 100 million more people with the condition around the world than previously thought.

Researchers from Australia, the UK and the US found the prevalence of global diabetes has been seriously underestimated by at least 25%.

In 2015, the official international estimate of the number of people with diabetes was 415 million, but the actual number may be as high as 520 million.

The inaccurate statistics are mostly due to inconsistent and inappropriate testing, says Monash professor of public health and diabetes Paul Zimmet.

“The way the global data on diabetes has been collected has been inconsistent, and not of the standard needed for public health planning to address what is now one of the largest chronic disease epidemics in human history,” says Professor Zimmet.

This inconsistency includes many countries using just the fasting glucose test and not including the additional test at two hours after a glucose drink.

“While the World Health Organization (WHO) recommends a blood glucose test – both fasting and at two hours after a glucose drink – only the fasting glucose is used in many instances, resulting in an underestimate of at least 25% in the number of new cases of diabetes,” he says.

An alternative test, HbA1c (hemoglobin A1c) is now being recommended by the WHO and the American Diabetes Association to circumvent the two-hour test, although the method’s efficacy is still unclear.

Complications and amputations

Most of the disease’s burden is due to complications, explain the researchers. These include excessive rates of coronary heart disease, heart failure, stroke, renal insufficiency and end-stage renal disease, retinopathy and blindness, peripheral sensory and motor neuropathy, and lower limb amputations.

More than 4,400 diabetes-related amputations are performed at Australian hospitals each year, says Diabetes Australia’s CEO, Associate Professor Greg Johnson.

“Australia’s health system is struggling to manage the growing burden of chronic disease, most notably type 2 diabetes. The fact that there are more than 4,400 diabetes-related amputations in Australia every year … underlines how critical this issue is,” says A/Prof Johnson.

“To put that in perspective – today around 12 people will undergo a diabetes-related amputation. Tomorrow – another 12 more amputations.

“Worryingly, surveys show that the general public underestimates the seriousness of diabetes and most people aren’t aware of the connection between diabetes and amputations,” he says.

A/Prof Johnson has called on the incoming Federal government and the state and territory governments to take action on the “national emergency”, by implementing a new prevention initiative “to end the tragedy of diabetes-related amputations within a generation”.

“Diabetes amputation prevention has to be a priority for every Primary Health Network in Australia,” he says.

Older people and treatment

For most older people with type 2 diabetes, continuous treatment with glucose-lowering medicines is required to reduce the risk of complications, says the Australian Institute of Health and Welfare (AIHW) in its latest report.

Metformin is the most commonly supplied medicine to manage type 2 diabetes among older people in Australia (69%), followed by sulfonylureas (40%). One in 5 (20%) older people with type 2 diabetes are supplied with insulin, 13% with DPP4 inhibitors, 5% with glitazones and 1% with exenatide.

Among Australians aged 65 and over in 2012, 325,579 had type 2 diabetes. Of these, 85% were supplied with glucose-lowering medicines; 15% had no recorded supply of glucose-lowering treatment through the PBS, with many of these people likely to be managing their diabetes with lifestyle measures alone, says the AIHW.

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